8 Journal of Consulting and Clinical Psychology Copyright 2006 by the American Psychological Association 2006, Vol. 74, No. 3, X/06/$12.00 DOI: / X Randomized Trial of Treatment for Children With Sexual Behavior Problems: Ten-Year Follow-Up Melissa Y. Carpentier Oklahoma State University Jane F. Silovsky and Mark Chaffin University of Oklahoma Health Sciences Center This study prospectively follows 135 children 5 12 years of age with sexual behavior problems from a randomized trial comparing a 12-session group cognitive behavioral therapy (CBT) with group play therapy and follows 156 general clinic children with nonsexual behavior problems. Ten-year follow-up data on future juvenile and adult arrests and child welfare perpetration reports were collected. The CBT group had significantly fewer future sex offenses than the play therapy group (2% vs. 10%) and did not differ from the general clinic comparison (3%), supporting the use of short-term CBT. There were no group differences in nonsexual offenses (21%). The findings do not support assumptions about persistent or difficult to modify risk and raise questions about policies and practices founded on this assumption. Keywords: sexual behavior problems, sexual offenses, children, recidivism, treatment Juvenile justice, child welfare, and mental health systems have devoted increasing attention to aggressive, victimizing, or highly inappropriate sexual behavior by preadolescent children (Araji, 1997; Baker, Schneiderman, & Parker, 2002; Chaffin, Letourneau, & Silovsky, 2002). Sexual behavior problems (SBP) do not represent a syndrome or diagnosable condition, but rather a set of behaviors. Although definitions of childhood SBP vary and persistent and developmentally atypical self-focused behaviors may be included in the definition, the dominant focus has been on children 12 years of age and under with intrusive sexual behaviors, usually directed at other and often younger children. Increased attention has been fueled by concerns over sexual aggression and child sexual abuse in general, and by efforts to intervene early in what has been perceived as a progressive behave noted that up to one half of adult sex offenders report a childhood or adolescent onset for their abusive sexual behaviors or interests and that early onset cases have particularly high numbers of offenses and victims (Abel et al., 1987; Hanson & Slater, 1988; Marshall, Barbaree, & Eccles, 1991). Although retrospective data do not accurately portray prospective risk, these findings have been interpreted as cause for long-term concern, and children with SBP have been viewed as posing a unique and potentially longterm risk to children in the community. For example, some state child welfare systems have promulgated special tracking systems for registering, segregating, and handling children identified as having SBP. Children with SBP may be segregated within facilities and limited to specialized SBP units. Because preadolescent

10 Journal of Consulting and Clinical Psychology 2009 American Psychological Association 2009, Vol. 77, No. 1, X/09/$12.00 DOI: /a A Randomized Clinical Trial of Multisystemic Therapy With Juvenile Sexual Offenders: Effects on Youth Social Ecology and Criminal Activity Charles M. Borduin University of Missouri Cindy M. Schaeffer Medical University of South Carolina Naamith Heiblum University of Missouri A randomized clinical trial evaluated the efficacy of multisystemic therapy (MST) versus usual community services (UCS) for 48 juvenile sexual offenders at high risk of committing additional serious crimes. Results from multiagent assessment batteries conducted before and after treatment showed that MST was more effective than UCS in improving key family, peer, and academic correlates of juvenile sexual offending and in ameliorating adjustment problems in individual family members. Moreover, results from an 8.9-year follow-up of rearrest and incarceration data (obtained when participants were on average 22.9 years of age) showed that MST participants had lower recidivism rates than did UCS participants for sexual (8% vs. 46%, respectively) and nonsexual (29% vs. 58%, respectively) crimes. In addition, MST participants had 70% fewer arrests for all crimes and spent 80% fewer days confined in detention facilities than did their counterparts who received UCS. The clinical and policy implications of these findings are discussed. Keywords: juvenile sexual offender, multisystemic therapy, MST, cognitive-behavioral therapy, randomized clinical trial Public concern about sex crimes is very high and has led to state and federal mandates for harsher sentences and other sanctions such as mandatory notification policies and sexual offender registries. Although arrests for sexual offenses are relatively rare, accounting for less than 1% of all arrests (U.S. Department of Justice, 2006), these crimes are among the most devastating to victims (Chapman, Dube, & Anda, 2007; Letourneau, Resnick, Kilpatrick, Saunders, & Best, 1996). Moreover, the societal costs of sexual offending are substantial. Indeed, in the United States, the estimated total annual cost to the public treasury for sexual (Pastore & Maguire, 2007; U.S. Department of Justice, 2006). This arrest statistic is especially disturbing when one considers that the ratio of self-reported to adjudicated sexual crimes by juveniles is approximately 25:1 (Elliott, 1995). There is also evidence that about one half of all adult sexual offenders commit their first sexual offense during adolescence (Zolondek, Abel, Northey, & Jordan, 2001) and that juvenile sexual offenders are more likely than juvenile nonsexual offenders and nonoffending adolescents to sexually reoffend as adults (Hagan, Gust-Brey, Cho, & Dow, 2001). Accordingly, juvenile sexual offenders are important to

12 Journal of Consulting and Clinical Psychology 2011 American Psychological Association 2011, Vol. 79, No. 5, X/11/$12.00 DOI: /a Effects of Multisystemic Therapy Through Midlife: A 21.9-Year Follow-Up to a Randomized Clinical Trial With Serious and Violent Juvenile Offenders Aaron M. Sawyer and Charles M. Borduin University of Missouri Objective: Although current evidence suggests that the positive effects of multisystemic therapy (MST) on serious crime reach as far as young adulthood, the longer term impact of MST on criminal and noncriminal outcomes in midlife has not been evaluated. In the present study, the authors examined a broad range of criminal and civil court outcomes for serious and violent juvenile offenders who participated on average 21.9 (range ) years earlier in a clinical trial of MST (C. M. Borduin et al., 1995). Method: Participants were 176 individuals who were originally randomized to MST or individual therapy (IT) during adolescence and averaged 3.9 arrests for felonies prior to treatment. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants were on average 37.3 years old. Results: Intent-to-treat analyses showed that felony recidivism rates were significantly lower for MST participants than for IT participants (34.8% vs. 54.8%, respectively) and that the frequency of misdemeanor offending was 5.0 times lower for MST participants. In addition, the odds of involvement in family-related civil suits during adulthood were twice as high for IT participants as for MST participants. Conclusions: The present study represents the longest follow-up to date of an MST clinical trial and demonstrates that the positive impact of an evidence-based youth treatment such as MST can last well into adulthood. Implications of the authors findings for policymakers and service providers are discussed. Keywords: juvenile offenders, randomized clinical trial, multisystemic therapy, MST, evidence-based treatment Serious and violent juvenile offenders continue to commit crimes well into adulthood (Laub & Sampson, 2001) and are at risk for a wide range of long-term negative outcomes, including low educational attainment, physical and mental health problems, and interpersonal and financial difficulties (Farrington, Ttofi, & Coid, 2009; Shepherd, Farrington, & Potts, 2004). Moreover, criminal offenses, whether committed by juveniles or adults, have harmful effects on victims, the families of victims and perpetrators, and the larger community (e.g., Poehlmann, Dallaire, Loper, & Shear, converted into dollar amounts and combined with criminal justice system costs (e.g., incarceration), the total economic impact of a single lifetime of crime ranges from $1.3 to $1.5 million (Foster, Jones, & the Conduct Problems Prevention Research Group, 2006). Thus, there is a critical need for treatments that can prevent or attenuate persistent criminal activity among serious juvenile offenders. Historically, mental health and juvenile justice services have had little success in ameliorating the serious antisocial behavior of

14 Article Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study John F. Clarkin, Ph.D. Kenneth N. Levy, Ph.D. Mark F. Lenzenweger, Ph.D. Otto F. Kernberg, M.D. Objective: The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment. Method: Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design. Results: Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transferencefocused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault. Conclusions: Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures. (Am J Psychiatry 2007; 164: ) Impulsivity, diminished nonaffective constraint, negative affectivity, and emotional dysregulation are core characteristics of borderline personality disorder (1 3). The prevalence of borderline personality disorder in the community is approximately 1.3% to 1.4% (4, 5). This chronic sons (14) and has demonstrated superiority over treatment as usual (unpublished data by KN Levy et al. available from the authors). A necessary and first step in illuminating effective treatments for borderline personality disorder is to show that a

16 Annu. Rev. Law. Soc. Sci : Downloaded from by Universitat Zurich- Hauptbibliothek Irchel on 10/14/11. For personal use only. Annu. Rev. Law Soc. Sci : First published online as a Review in Advance on July 5, 2007 The Annual Review of Law and Social Science is online at This article s doi: /annurev.lawsocsci Copyright c 2007 by Annual Reviews. All rights reserved /07/ $20.00 The Effectiveness of Correctional Rehabilitation: A Review of Systematic Reviews Mark W. Lipsey 1 and Francis T. Cullen 2 1 Institute for Public Policy Studies, Vanderbilt University, Nashville, Tennessee 37212; 2 Division of Criminal Justice, University of Cincinnati, Cincinnati, Ohio ; Key Words treatment, deterrence, sanctions, offenders, meta-analysis Abstract The effects of correctional interventions on recidivism have important public safety implications when offenders are released from probation or prison. Hundreds of studies have been conducted on those effects, some investigating punitive approaches and some investigating rehabilitation treatments. Systematic reviews (meta-analyses) of those studies, while varying greatly in coverage and technique, display remarkable consistency in their overall findings. Supervision and sanctions, at best, show modest mean reductions in recidivism

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